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Parathyroid dual tracer subtraction scintigraphy: small regions method for quantitative assessment of parathyroid adenoma uptake

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Abstract

Objective

The aim was quantitative assessment of parathyroid adenoma (PTA) uptake in dual tracer dynamic scintigraphy.

Methods

In 78 patients, median age 58 (19–80) years, surgically treated for primary hyperparathyroidism (PHPT), with parathyroid hormone median 125 (70–658) pg/ml, we performed preoperative parathyroid scintigraphy, following EANM guidelines of subtraction and double-phase protocol (2009) using two tracers: Tc-99m pertechnetate and Tc-99m MIBI. In addition to standard subtraction processing and visual interpretation of delayed MIBI planar images of neck and mediastinum in oblique sections (positions according to ultrasound PTA localisation), we developed Submarine processing software that enables selecting custom regions grid sizes ≥6 mm (as this solution was not present in commercial software) to follow time activity curve changes in thyroid tissue and PTA. Histopathology in 53/78 patients revealed PHPT and in 25/78 patients thyroid nodular disease only, and thyroid malignancy occurred in total of 15/78 (19 %) patients. PHPT group included 44 solitary PTA, 8 patients with hyperplasia and one parathyroid carcinoma. The median macroscopic volume of PTA was 717.5 (15–6125) mm3. Concomitant PHPT and thyroid nodular disease occurred in 24/53 patients and among them 8 patients had thyroid malignancies.

Results

PTA showed typical pattern of late peak on time activity curves characterized by median start time on 15 (10–25) min, the peak amplitude mean 19 (±5) % above thyroid declining washout curve, and duration of peak 6 (4–10) min, allowing PTA to “emerge” like submarine, independent from thyroid tissue and lesions. The ratio of PTA-to-normal thyroid uptake at peak maximum was 1.35 (±0.21). The thyroid TACs results of normal 29/78 (37 %) patients, benign nodular 34/78 (44 %) patients, and malignancy in 15 (19 %) patients were all presented by declining exponential curves. The slope analysis of TACs in normal thyroid tissue, thyroid benign and malignant lesions (linear fitted logarithm of TAC) showed no difference (the same negative slope: −0.04). Submarine processing was sensitive in detection of small lesions, in hyperplasia, and concomitant thyroid nodular disease.

Conclusions

The novel Submarine processing confirmed specific PHPT pattern and was effective in the group with potential pitfalls of standard interpretation, increasing sensitivity and specificity of standard processing subtraction algorithm. Prolonged MIBI accumulation was present in malignant as well as benign thyroid nodules with identical TAC slope.

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Acknowledgments

We thank Professor Dejan B. Popović, Faculty of Electrical Engineering, University of Belgrade, Serbia, for reading the manuscript and making suggestions for presenting the results. We thank the following observers: prim. Zeljka Aleksić and Dr. Mirjana Milićević, Department of Nuclear Medicine, Medical Center of Zaječar, Zaječar, Serbia; prim. Slobodan Tasić, Department of Nuclear Medicine, National Cancer Research Center of Serbia, Belgrade, Serbia; Dr. Ljiljana Bojić, Department of Nuclear Medicine, Clinical Centre of Montenegro, Podgorica, Montenegro; and biomedical engineer Vladimir Kojić, M.Sc., Faculty of Electrical Engineering, University of Belgrade, Sebia.

Conflict of interest

No potential conflicts of interest were disclosed.

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Authors and Affiliations

  1. Department of Nuclear Medicine, National Cancer Research Center of Serbia, Pasterova 14, 11000, Belgrade, Serbia

    Ana Koljević Marković

  2. Department of Signals and Systems, University of Belgrade - Faculty of Electrical Engineering, Bulevar kralja Aleksandra 73, 11000, Belgrade, Serbia

    Milica M. Janković

  3. Department of Surgery, National Cancer Research Center of Serbia, Pasterova 14, 11000, Belgrade, Serbia

    Ivan Marković & Radan Džodić

  4. Department of Surgery, Faculty of Medicine, University of Belgrade, Pasterova 14, 11000, Belgrade, Serbia

    Ivan Marković & Radan Džodić

  5. Department of Pathology, National Cancer Research Center of Serbia, Belgrade, Serbia

    Gordana Pupić

  6. Faculty of Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland

    Angelika Bischof Delaloye

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  1. Ana Koljević Marković
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Correspondence to Ana Koljević Marković.

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Koljević Marković, A., Janković, M.M., Marković, I. et al. Parathyroid dual tracer subtraction scintigraphy: small regions method for quantitative assessment of parathyroid adenoma uptake. Ann Nucl Med 28, 736–745 (2014). https://doi.org/10.1007/s12149-014-0867-0

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  • DOI: https://doi.org/10.1007/s12149-014-0867-0

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